Inflammatory intramammary lymph node mimicking the malignant lesion in dynamic MRI: a case report

Enlarged intramammary lymph node (LN) may be caused by inflammation [Arch. Surg. 109 (1974) 759.], reaction to dermatitis [Radiology 137 (1980) 15.], tuberculosis [Histopathology 17 (1990) 91.], foreign body such as gold [Hum. Pathol. 19 (1988) 992.], neoplasm including metastasis [Arch. Surg. 109 (1974) 759; AJR, Am J Roentgenol 146 (1986) 133.], and malignant lymphoma [AJR, Am J Roentgenol 161 (1993) 779.]. It is difficult to distinguish benign enlarged LNs from malignant lesion clinically, mammographically, and sonographically. There have been a few reports on the magnetic resonance imaging (MRI) of enlarged intramammary LNs in the English literature. In this article, we present a case in which dynamic MRI indicated inflammatory LNs as highly suspicious of malignancy.     

Angiotensin II enhances glomerular expression of a nonmuscle myosin heavy chain, SMemb, with extracellular matrix accumulation

BACKGROUND/AIMS: We previously showed that the mesangial expression of nonmuscle-type myosin heavy chain, SMemb, was related to glomerular sclerosis. Although angiotensin II (AII) is known to promote the glomerular accumulation of extracellular matrix and sclerosis, the effect of AII on the mesangial expression of SMemb is unknown. Thus, we investigated the effect of AII on the mesangial expression of SMemb and synthesis of fibronectin. METHODS: We continuously administered AII to Sprague-Dawley rats with subcutaneous osmotic minipumps for 14 days. Control animals received normal saline instead. The effects of oral administration of an AII type 1 (AT1) receptor antagonist, candesartan cilexetil, and a vasodilator, hydralazine, were also examined. RESULTS: Semiquantitative immunohistochemical evaluation and Western blot analysis showed that AII significantly enhanced glomerular expression of SMemb (0.87 +/- 0.33 vs. 0.40 +/- 0.19 for immunohistochemical grading, p < 0.05; 2.55 +/- 0.88 vs. 1.16 +/- 0.75 for Western blot analysis, p < 0.05). Glomerular fibronectin was also increased in AII-administered rats (301.7 +/- 206.8 ng/5 microg protein vs. 95.8 +/- 81.3 ng/5 microg protein, p < 0.05). Candesartan cilexetil attenuated these effects. On the other hand, hydralazine did not change the glomerular expression of SMemb enhanced by AII administration. CONCLUSION: All induced a phenotypic alteration in mesangial cells, enhanced the mesangial expression of SMemb and stimulated the fibronectin synthesis. These results suggest that the mesangial expression of SMemb is related to glomerular matrix accumulation and that AII mediates both mesangial processes via AT1 receptors.     

A novel PHOX2B gene mutation in an extremely low birth weight infant with congenital central hypoventilation syndrome and variant Hirschsprung's disease

Congenital central hypoventilation syndrome is a disorder of respiratory control caused by mutations in the paired-like homeobox 2B gene. Mutations in the paired-like homeobox 2B gene are also responsible for Hirschsprung's disease. Variant Hirschsprung's disease is a rarer disorder that does not meet the diagnostic criteria of Hirschsprung's disease, although severe functional bowel obstruction persists. We present a case of an extremely low birth weight infant with congenital central hypoventilation syndrome and variant Hirschsprung's disease. A male infant who was diagnosed to have fetal growth restriction and polyhydramnios was delivered by emergency cesarean section at 30 weeks and 3 days of gestational age due to non-reassuring fetal status. The birth weight was 979 g, and intensive care was started immediately following delivery. The patient exhibited refractory apnea and was diagnosed with congenital central hypoventilation syndrome by genetic testing of the paired-like homeobox 2B gene. The patient also exhibited refractory functional bowel obstruction and was diagnosed to have variant Hirschsprung's disease through pathological examination of his intestinal specimens. The patient grew slowly but surely with intensive care including mechanical ventilation and parenteral nutrition. However, the patient repeatedly suffered from sepsis and died of fungemia at 197 days of age. This is the first congenital central hypoventilation syndrome case that was accompanied with variant Hirschsprung's disease, and the paired-like homeobox 2B mutation detected in this case (NM_003924.3: c.441G > C; p.(Gln147His)) is novel. This case suggests that the paired-like homeobox 2B mutation causes not only congenital central hypoventilation syndrome and Hirschsprung's disease, but also variant Hirschsprung's disease in humans. It also highlights the extreme difficulty in treating premature infants with severe and prolonged functional bowel obstruction.     

Bronchoscopic and transthoracic cytology and biopsy for pulmonary nonsmall cell carcinomas: performance characteristics by procedure and tumor type

Recent advances have increased the demand for the accurate diagnosis of pulmonary nonsmall cell carcinoma (NSCLC) rendered by biopsy or cytology. However, precise classification is not possible in all cases. In this study, we investigated the performance characteristics of preresection bronchoscopic and transthoracic procedures for the diagnosis of NSCLC. The pathology files were searched for resected NSCLCs and carcinoid tumors with corresponding preresection cytology and/or biopsy cases. The preresection diagnoses were correlated with the resection diagnosis and the type of bronchoscopic or transthoracic procedure. Among the bronchoscopic procedures, endobronchial/transbronchial biopsy (ETBX) had the highest yield for obtaining a positive (malignant) diagnosis and was the best procedure for obtaining precise classification. For transthoracic procedures, fine-needle aspiration (FNA) and needle core biopsy (NCB) were similar in providing a positive (malignant) diagnosis; however, NCB was better than FNA in obtaining precise classification. From the perspective of the neoplasms, carcinoid tumors yielded a positive (malignant) specimen with accurate classification most often (e.g., 100% by ETBX). This was followed by squamous cell carcinoma and adenocarcinoma. In contrast, precise classification was not possible for adenosquamous carcinoma, large cell carcinoma, and large cell neuroendocrine carcinoma. Bronchoscopic and transthoracic procedures have different performance characteristics. Furthermore, the diagnostic yield is dependent on the histologic type of the neoplasm. While carcinoid tumors are accurately classified in most cases, some other neoplasms are difficult to diagnose and subclassify due to histologic complexity, poor differentiation, or sampling limitations.